Special Surgical Techniques

Conventional surgery makes large incisions (or cuts) through the skin, muscle, and other layers of the body. When most people think of surgery, they picture a doctor using a scalpel and other surgical instruments to cut into and remove, repair, or replace parts of the body affected by disease. Learn more about conventional cancer surgery in How Surgery Is Used for Cancer.

Newer surgical techniques are less invasive, use different types of surgical instruments, and lead to less pain and shorter recovery times. Some of these techniques are described here.

Laser surgery

A laser is a highly focused and powerful beam of light energy which can be used for very precise surgical work. It can be used instead of a blade or scalpel to cut through tissue. It can also be used to burn and destroy (vaporize) tumors or precancerous growths and treat cancers of the cervix, penis, vagina, vulva, lung, and skin.

Some laser surgery involves less cutting and damage (they’re less invasive) than standard surgery. For instance, with fiber optics and special scopes the laser can be directed inside a natural body opening without having to make a large cut. The laser is then precisely aimed to destroy the tumor.

Lasers are also used in a type of surgery called photoablation or photocoagulation to destroy tissues or seal tissues or blood vessels. This type of surgery is often used to relieve symptoms, such as when large tumors block the windpipe (trachea) or swallowing tube (esophagus), causing problems breathing or eating.

Cryosurgery

Cryosurgery uses a liquid nitrogen spray or a very cold probe to freeze and kill abnormal cells. This technique is sometimes used to treat pre-cancerous conditions, like those affecting the skin, cervix, and penis. Cryosurgery can also be used to treat some cancers, like those in the liver and prostate. A scan (like an ultrasound or CT scan) might be used to guide the probe into the cancer and watch the cells freeze. This limits damage to nearby healthy tissue.

Electrosurgery

A high-frequency electrical current can be used to destroy cells. This may be done for some cancers of the skin and mouth.

Radiofrequency ablation

In radiofrequency ablation, or RFA, high-energy radio waves are sent through a needle to heat and destroy cancer cells. RFA may be used to treat cancer tumors in the liver, lungs, kidney, and other organs.

Mohs surgery

Mohs micrographic surgery is also called microscopically controlled surgery. It’s used to remove certain skin cancers by shaving off one very thin layer at a time. After each layer is removed, the doctor looks at the tissue with a microscope to check for cancer cells. This procedure is repeated until all the cells in a layer look normal.

Mohs surgery is used when the extent of the cancer is not known or when as much healthy tissue as possible needs to be saved, such as when treating skin cancers near the eye.

Chemosurgery is an older name for surgery like this and refers to certain drugs that may be put on the tissue before it’s removed. Mohs surgery does not use chemotherapy drugs.

Laparoscopic surgery

A laparoscope is a long, thin, flexible tube that can be put through a small cut to look inside the body. It’s sometimes used to take pieces of tissue to check for cancer. In recent years, doctors have found that by making small holes and using special long, thin instruments, the laparoscope can be used without making a large cut. This can help reduce blood loss during surgery and pain afterward. It can also shorten hospital stays and allow people to heal faster. Laparoscopic surgery is used commonly today for many other operations.

Laparoscopic surgery can be used in cancer treatment, but not for all cancers. Doctors can safely and effectively to use laparoscopic surgeries for some cancers of the colon, rectum, liver, prostate, uterus, and kidney, among others. Uses on other types of cancer are still being studied.

Thoracoscopic surgery

A thoracoscope is a thin tube with a tiny video camera on the end that can be put through a small cut into the chest after the lung is collapsed. This allows the doctor to see inside the chest. Tissue samples of any areas of concern on the lining of the chest wall can be taken out, fluid can be drained, and small tumors on the surface of the lung can be removed.

This type of surgery leads to less cutting and has even been used to remove parts of the lung that contain cancer. Studies have shown that for early-stage lung cancer, results using this approach are much the same as removing part of the lung through a cut in the side of the chest.

Robotic surgery

Robotic surgery is a type of laparoscopic (or thoracoscopic) surgery where the doctor sits at control panel and uses precise robotic arms to control the scope and other special instruments. The advantages of this type of surgery are largely the same as laparoscopic and thoracoscopic surgery: it can help reduce blood loss during surgery and pain afterward. It can also shorten hospital stays and let people to heal faster.

Robotic surgery is sometimes used to treat cancers of the colon, prostate, and uterus. It has also been cleared for use by the FDA in operating on other body systems. It’s not yet clear if robotic surgery leads to better long-term results than operations where the surgeon holds the instruments directly.

Other forms of surgery

Doctors are always looking for new ways to remove or destroy cancer cells. Some of these methods are blurring the line between what we commonly think of as surgery and other forms of treatment.

Researchers are testing many new techniques, like using high-intensity focused ultrasound, microwaves, and even high-powered magnets to try to get rid of unwanted tissue. These techniques are promising, but still largely experimental.

As doctors have learned how to better control the energy waves used in radiation therapy, some newer radiation techniques that work almost as well as surgery have been found. By using radiation sources from different angles, stereotactic radiation therapy delivers a large precise radiation dose to a small tumor area. The process is so exact that this is sometimes called stereotactic surgery, even though no cut is actually made. In fact, the machines used to deliver this treatment have names like Gamma Knife® and CyberKnife®, but no knife is involved. The brain is the most common site that can be treated using this technique, but it’s also used on some head, neck, lung, spine, and other tumors. Researchers are looking for ways to use it to treat other types of cancer, too.

Some things to remember

The best chance of a cure from many types of cancer is to remove all of the cancer as soon as possible after diagnosis. If you have a solid tumor, sometimes surgery alone will cure the cancer, but you might need chemotherapy, radiation therapy, or other treatment, too. Your health care provider will discuss your best treatment options with you.

If you have any concerns about surgery or cancer, discuss this issue with the people who know your situation best – your surgeon and other members of your cancer care team.